Short-term prognostic factors in the patients after acute heart failure

Abstract

To explore risk factors of short-term prognosis of acute heart failure (AHF) patients and compare the difference between acute heart failure with reduced ejection fraction (AHFREF) and acute heart failure with preserved ejection fraction (AHFPEF). A retrospective analysis of medical records of AHF patients was performed. Eligible patients were at the age of more than 18 years old, excluding malignancy, acute pulmonary embolism, heart valve diseases (such as mild valvular regurgitation), severe renal insufficiency, and N-terminal pro-brain natriuretic peptide (NT-proBNP) < 300 pg/ml. AHFREF group (LVEF < 0.5) and AHFPEF group (LVEF ≥ 0.5) were classified depending on the left ventricular ejection fraction (LVEF). The involved patients were followed up via telephone contact and consult of medical recording. Unfavorable prognosis was defined upon the cardiac death and re-hospitalization within 6 months; otherwise they had a favorable prognosis. We analyzed the impact factors of short-term prognosis, including patient's age, gender, systolic blood pressure, diastolic blood pressure, heart rate, NT-proBNP, blood glucose, heart ultrasound LVEF, cardiothoracic ration in chest radiograph, history of hypertension, coronary heart disease and diabetes mellitus, for multivariate logistic regression analysis. A total of 130 AHF patients were included in the analysis, including 79 male (60.8%) and 51 female (39.2%). The average age of all involved patients was 74.0 years [M (P 25, P 75) = 64.0, 80.0]. Fifteen cases (11.5%) had unfavorable prognosis and 35 cases (27.0%) had favorable prognosis in the AHFREF group, while the cases in the AHFPEF group were respectively 31 (23.8%) and 49 (37.7%). There was no significant difference in the short-term prognosis between the two groups (χ (2) = 1.030, P = 0.310). The short-term prognosis in AHF patients was mainly influenced by NT-proBNP (r = -0.263, P = 0.035), blood glucose (r = -0.090, P = 0.049) and systolic blood pressure (r = 0.012, P = 0.030). As for AHFREF patients, systolic blood pressure (r = 0.047, P = 0.014) and LVEF (r = 10.991, P = 0.037) were the predominant factors; as for AHFPEF patients, NT-proBNP was the major risk factor (r = -0.319, P = 0.033). High NT-proBNP, high blood sugar and low systolic blood pressure at visits are the risk factors for short-term prognosis of AHF patients. Due to different LVEF baseline levels of AHFREF and AHFPEF, the prognosis factors also vary. Low systolic blood pressure and LVEF are the risk factors of AHFREF, while high NT-proBNP is risk factor of AHFPEF.

Keywords: N-terminal pro-brain natriuretic peptide; Systolic blood pressure; acute heart failure; blood glucose; ejection fraction; prognosis.